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PubMed1986

Functional amaurosis: diagnostic value of electronystagmography.

Hysterical and malingered blindness may be distinguished from organic ocular and cortical blindness by a variety of clinical and electrophysiological tests. This report discusses the limitations of these tests and emphasizes the objective superiority of a new test which utilizes the electronystagmographic technique. This test is based on the principle that visual input blocks nystagmus induced by vestibular stimulations: the presence of nystagmus suppression will indicate that blindness is either hysterical or malingered.

Blindness↗
PubMed1997

Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder.

OBJECTIVE: The skepticism regarding the existence of dissociative identity disorder as well as the abuse that engenders it persists for lack of objective documentation. This is doubly so for the disorder in murderers because of issues of suspected malingering. This article presents objective verification of both dissociative symptoms and severe abuse during childhood in a series of adult murderers with dissociative identity disorder. METHOD: This study consisted of a review of the clinical records of 11 men and one woman with DSM-IV-defined dissociative identity disorder who had committed murder. Data were gathered from medical, psychiatric, social service, school, military, and prison records and from records of interviews with subjects' family members and others. Handwriting samples were also examined. Data were analyzed qualitatively. RESULTS: Signs and symptoms of dissociative identity disorder in childhood and adulthood were corroborated independently and from several sources in all 12 cases; objective evidence of severe abuse was obtained in 11 cases. The subjects had amnesia for most of the abuse and underreported it. Marked changes in writing style and/or signatures were documented in 10 cases. CONCLUSIONS: This study establishes, once and for all, the linkage between early severe abuse and dissociative identity disorder. Further, the data demonstrate that the disorder can be distinguished from malingering and from other disorders. The study shows that it is possible, with great effort, to obtain objective evidence of both the symptoms of dissociative identity disorder and the abuse that engenders it.

Adult↗
PubMed1996

Feigned psychiatric symptoms in the emergency room.

Psychiatrists providing emergency services at an urban general hospital completed questionnaires on 227 patients evaluated over a two-month period to assess whether they suspected the patient of malingering or of having secondary gains, and whether the patient was confronted about the suspicions. Thirteen percent of patients were strongly or definitely suspected of feigning symptoms; none received a primary diagnosis of malingering, and less than half were confronted. Suspected secondary gains included food and shelter, medications, financial gains, and avoidance of jail, work, or family responsibilities.

Adult↗
PubMedDate not supplied

Cochlear, brain stem, and cortical evoked responses in nonorganic hearing loss.

After complete but inconclusive audiometric evaluation, 30 suspected cases of nonorganic hearing loss (NOHL) were referred to this laboratory for a complete battery of electric response audiometry tests (recording of cochlear, brain stem and cortical evoked responses). The chief advantages of these tests lie in their ability to more objectively confirm the presence of NOHL and to elicit the true threshold of the subject. Such tests along with psychiatric evaluation, indicate that NOHL can be subdivided into categories, examples of which are presented and discussed: malingering or conscious simulation of deafness for obvious personal gain, and psychogenic deafness in which an emotional problem (e.g., combat stress, anxiety) is unconsciously converted into a hearing problem in an escape mechanism. The basis of NOHL in some cases may be a mixture of both conscious components (malingering) and unconscious components (psychogenic). Several cases of NOHL are really nonorganic overlays or exaggeration on a small to moderate organic hearing loss. The psychogenic hearing loss seen in soldiers with combat neurosis may have originally developed as a psychogenic exaggeration of a temporary threshold shift induced by the noise of battle. Thus objective electrophysiological hearing tests and psychiatric evaluation have contributed to a better understanding of NOHL.

Adolescent↗
PubMed2001

Subtypes of clinical presentations in malingerers of posttraumatic stress disorder: an MMPI-2 cluster analysis.

This paper investigated subtypes of individuals trained and instructed to malinger Posttraumatic Stress Disorder (PTSD) through a cluster analysis of their Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical and validity scales. Participants were 84 men and women college students at a community college in the southeastern United States. Two well fitting MMPI-2 cluster solutions were evaluated with discriminant analyses and multivariate analyses of variance (MANOVAs); a 2-cluster solution was deemed optimal. Significant between-cluster differences emerged in follow-up analyses on most of the content scales of the MMPI-2. Most demographic variables did not account for differences in cluster membership. Clusters differed in their reported clarity of the materials used to educate them about PTSD. Discriminant analyses yielded better correct classification rates than those from previous studies, when the more severely symptomatic cluster was compared with a sample of clinical combat-related PTSD veterans. Implications are considered in conducting future malingered PTSD investigations.

Adolescent↗
PubMed1998

The PAI and feigning: A cautionary note on its use in forensic-correctional settings.

Indicators of feigned PAI profiles were derived from comparisons of simulators instructed to feign and genuine patient groups. Concerns are raised regarding whether these indicators are applicable to forensic and correctional populations and can be cross-validated with a known-groups comparison. Compiling data on 57 malingerers and 58 genuine patients from two forensic and correctional sites, three primary indicators of feigning, Negative Impression (NIM) scale, Malingering Index, and the Rogers Discriminant Function (RDF) were investigated. Results suggested that the RDF was not applicable to forensic referrals. However, NIM 77T appeared to be a useful screen for forensic samples. In addition, convergent evidence of feigning was found across designs (simulation and known-groups) and samples (non-forensic and forensic) for extreme elevations on NIM (>/=110T) and Malingering Index (>/=5).

Adult↗
PubMed1995

Impact of simulating borderline personality disorder on the MMPI-2: a costs-benefits model employing base rates.

This investigation extends current work on the impact of role-specific response sets on dissimulated Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) profiles. Specifically, one group of subjects was given specific symptom information and instructed to simulate borderline personality disorder on the MMPI-2. This dissimulation performance was compared to a clinical comparison group of clients diagnosed with borderline personality disorder, a group of subjects instructed to simulate major depression, and a group of subjects who responded honestly to the MMPI-2. In both simulating conditions, subjects produced significantly higher elevations on a majority of clinical and validity scales than the clinical comparison group. A rigorous evaluation of the F scale was conducted to provide a range of predictive values for different F scale cutting scores for detecting malingering. Sensitivity, specificity, and positive and negative predictive power were computed for this range of F scale values. A similar analysis was conducted for the Borderline Personality Disorder Scale (BPDsc) of Morey, Waugh, and Blashfield (1985). These results are integrated with extant research. A costs-benefits model is proposed for employing F scale cutting scores in clinical situations with different base rates of malingering.

Adolescent↗
PubMed1995

Psychiatric aspects of chronic pain.

Chronic pain complaints often reflect or are influenced by psychiatric factors. Physicians commonly encounter "illness-affirming behaviors" in which patient complaints or symptoms go beyond what should be expected from a specific disease process. In this paper, I describe common psychiatric conditions that often feature pain as part of the illness: somatization disorder, hypochondriasis, factitious physical disorders, pain associated with psychological factors (new DSM-IV nomenclature), and malingering. These conditions can be distinguished based on the conscious awareness (or lack of awareness) of both motivation and symptom production. Other psychiatric disorders may strongly influence chronic pain without directly causing it--depression, anxiety, panic, and post-traumatic stress disorders. Except for malingering and factitious pain, chronic pain should be regarded as genuine. Effective management requires psychiatric as well as biological considerations.

Adult↗
PubMed1993

Psychiatric norms for the Rey 15-item Visual Memory Test.

The 15-item Visual Memory Test was proposed by Rey in 1964 as a measure of malingering of visual memory. Among psychiatric patients the task has a significant cognitive component, with IQ accounting for 37% of the variance in scores (r = .60). Any interpretation of scores on this task should be ability-based. Such ability-based norms are provided in this study of psychiatric patients (N = 300). Use of a single cut-off score to indicate malingering or any other interpretation is inappropriate given the psychometric properties of the task. In the assessment of immediate visual memory the task has some utility, which is greatly enhanced with the use of ability-based norms.

Adult↗
PubMed1994

Validity of neuropsychological test results in disability evaluations.

A group of 50 disability claimants referred by the Social Security Administration for neuropsychological screening were administered a 36-item, forced-choice, digit-recognition method of detecting malingering to assess effort and motivation to perform well. This abbreviated form of the 1989 Hiscock and Hiscock Forced-choice Procedure has been shown to be quite easy even for individuals with severe organic brain dysfunction. A perfect performance of 36 correct on this digit-recognition task is obtained by most individuals with moderate to severe brain damage. A performance of less than 90% correct is due more likely to poor effort or even malingering rather than brain damage. In this sample, 18% (n = 9) obtained scores of less than 90% correct, i.e., < 33, which calls into question the reliability and validity of test data obtained. An additional 20% (n = 10) obtained intermediate scores of 33 to 35 correct. These intermediate scores are more difficult to interpret although at least some proportion of those scores reflects poor motivation. The results over-all indicate that nearly one-fifth of potential disability claimants produced invalid and uninterpretable neuropsychological test protocols and an additional one-fifth obtained protocols that should be well scrutinized for evidence of poor effort as well. Neuropsychologists conducting disability evaluations are urged to use measures designed specifically to assess effort and motivation.

Adult↗
PubMed2004

The effect of depression and anxiety on the TOMM in community-dwelling older adults.

Tests of possible malingering are in increasing demand among neuropsychologists. The Test of Memory Malingering (TOMM) is resistant to many neurological conditions, including traumatic brain injury, dementia, and aphasia. Less clear is the impact of psychological conditions on TOMM performance. This study examined a sample of community-based older adults (55-75) to determine whether scores on the TOMM are influenced by the presence of symptoms of depression or anxiety, as measured by the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI), respectively. The results indicate that, regardless of BDI or STAI scores, all subjects scored above 45 correct out of 50 on TOMM Trial 2. These findings demonstrate that depression and anxiety levels in an older community-dwelling sample do not negatively affect performance on the TOMM.

Aged↗
PubMedDate not supplied

[Evaluating the simulation of memory problems within the legal and forensic fields].

The present article is a theoretic review of the techniques used to assess the malingering of memory problems in the forensic and legal context. The necessity of instruments to facilitate the detection of malingerers is confirmed. This phenomenon is more relevant in the memory pathology context because their exaggeration or false performance is very common. The reason of this preference is the ease of the simulation of these very well known symptoms. The consequences, economics primarily, of the confirmation of brain damage sequels have produced that malingerers are well informed about the characteristics of this syndrome. This review is focus on, both tests assessing different components of memory, such as the Wechsler Memory Scale III and the California Verbal Learning Test, and tests designed specifically to detect malingering. We also differentiate tests assessing explicit and implicit memory. Likewise, future lines of research are proposed in this important legal context.

Brain Injuries↗
PubMed1988

Neuropsychiatric assessment of a spinal cord injury patient with sudden recovery.

Reported here is the case of a 23-year-old man who, presenting as a spinal cord injury patient with paraplegic and bilateral sensory impairments in the legs, made a rather dramatic recovery after receiving a trivial jolt while moving about in his wheelchair. In addition to clinical findings, both hypnotic and somatosensory evoked potential test results were used to help determine whether there was or was not actual spinal cord injury and whether there was or was not a psychologic overlay involving either malingering or a conversion disorder. In this case, evidence pointed to malingering in the presence of a minor spinal cord injury documented by somatosensory evoked potential patterns.

Adult↗
PubMed1987

Competency to stand trial: a conceptual model for its proper assessment.

The assessment of competency to stand trial is frequently fraught with conceptual confusion resulting from a failure to properly apply the data of the clinical examination to the relevant legal criteria. A basic question scheme that encompasses (1) the defendant's psychiatric status, (2) the effects of that status on his functioning, and (3) his apparent ability to participate in legal proceedings, is introduced to clarify the evaluation of fitness to stand trial. The way in which combinations of answers to three "basic questions" generate a scheme that clarifies the difficulties encountered in most competency evaluations is shown. Eight paradigm cases are generated. Five of these (competence, incompetence, mentally ill but competent, malingering, and impaired but competent) are frequently straightforward. However, the three possibilities in which a defendant meets criteria entailed by two of the three questions are inherently subject to controversy. These situations (circumscribed psychosis related to the charges, malingering in the context of mental illness, and functional deficits in the context of minor mental illness) are discussed in detail and illustrated with case material.

Adult↗
PubMed1985

The California syndrome. Functional visual complaints with potential economic impact.

The records of 84 patients with functional visual loss (59 adults and 25 children) were reviewed over a six-year period. The patients were between 7 and 69 years of age. In the young patients, psychosocial problems relating to parental divorce, poor school performance and attention-getting behavior were common, while in adult patients, financial gain was present in 51 of 59 (86%) individuals. Over 90% of the claimed abnormalities related to the afferent visual system. Fifty-three percent of the patients had underlying organic problems with functional overlay. Inconsistent test results were the most reliable means of identifying the malingering patients. In California, both ophthalmologists and optometrists are able to declare a patient legally blind as well as visually disabled for the purpose of income tax, workers' compensation, and disability benefits. The potential financial impact of malingering patients is discussed.

Adolescent↗
PubMed1978

Cancer pathomimicry: a report of three cases.

Three cases of alleged and feigned cancer are presented. The diagnostic and management problems presented are discussed through a review of the literature of feigned illness. This ranges across a spectrum from benign use of feigned or alleged symptoms, malingering, conversion reactions and hysterical manifestations to the severe and flamboyant clinical presentation of the Munchausen Syndrome. The cases presented mainly fit the criterion for malingering (conscious prevarication and simulation), although some elements of the Munchausen dynamics were present in two of the three. Also noteworthy was the fact that the "cancers" were presented to administration and lay people as an initial communication. The psychiatric consultation was with the lay people initially and the events of each episode were reconstructed through multiple sources of information including clinical interviews in two of the cases.

Adolescent↗
PubMed1995

Rey 15-item memorization and Dot counting scores in a "stress" claim worker's compensation population: relationship to personality (MCMI) scores.

The relationship between apparent faking of cognitive impairment (as detected by such "malingering" tests as 15-item Memorization and Dot Counting) and faking of psychiatric symptoms has not been investigated formally. In addition, no empirical literature is available on the relationship between personality traits and faking of cognitive symptoms. Of 154 subjects who claimed "stress" psychiatric injury, 12% appeared to be faking cognitive impairment; 4.5% failed the 15-item Memorization Test, and 10% failed the Dot Counting task. Faking of cognitive symptoms occurred in only 23% of subjects who were faking/exaggerating psychological symptoms on the MCMI. Malingering test failure was associated with significant elevations on MCMI personality scales, although this appeared to be an artifact of attempts to fake/exaggerate on the MCMI, rather than a reflection of "true" personality traits.

Adolescent↗
PubMed2002

Lie detection by functional magnetic resonance imaging.

The accurate detection of deception or lying is a challenge to experts in many scientific disciplines. To investigate if specific cerebral activation characterized feigned memory impairment, six healthy male volunteers underwent functional magnetic resonance imaging with a block-design paradigm while they performed forced-choice memory tasks involving both simulated malingering and under normal control conditions. Malingering that demonstrated the existence and involvement of a prefrontal-parietal-sub-cortical circuit with feigned memory impairment produced distinct patterns of neural activation. Because astute liars feign memory impairment successfully in testing once they understand the design of the measure being employed, our study represents an extremely significant preliminary step towards the development of valid and sensitive methods for the detection of deception.

Adult↗